African recommendations for diagnosis and management of systemic juvenile idiopathic arthritis (sJIA) – a PAFLAR initiative

To develop evidence-based recommendations for diagnosis and treatment of children and adolescents with systemic juvenile idiopathic arthritis (sJIA), taking into consideration the socioeconomic status and availability of medications in African countries. A steering group composed of five PAFLAR members formulated questions in PICO format (Patient/Population, Intervention, Comparison, Outcome), conducted a systematic literature review, and identified experts in pediatric rheumatology throughout Africa. The Delphi method was used to reach consensus among the experts on the recommendations for diagnosis and treatment of sJIA patients. The online Delphi questionnaire was sent to the 22 experts selected by the steering committee, who were asked to vote for each statement and to provide their suggestions for modifications or rewording. A 100% response rate was obtained. A minimum agreement of 70% among the voting panel was required. A total of 15 recommendations were formulated, 4 regarding diagnosis and 11 regarding treatment. The percentage of agreement with the recommendations ranged from 72.7% to 95%. We present the first African recommendations for diagnosis and management of sJIA. The feedback about the application of these recommendations in pediatric rheumatology centers will serve as the basis for future revisions in the light of African-specific experiences and insights.